MedicaidReimbursementHigh impact
PT 33-26: Billing Clarification for Toxicology Testing and Pain Management Clinics
Maryland Medicaid·MD · Pain Management·Claims & Billing
Effective date
Nov 13, 2025
We identified it
Jun 18, 2026
Summary
Maryland Medicaid clarifies that MCOs (not the Behavioral Health Organization) are responsible for reimbursing toxicology testing performed by pain management providers in their own offices. Pain management clinics can bill multiple drug testing codes on the same day if they perform testing in-house without referring to independent labs.
Action Required
Immediately: Pain management billing teams in Maryland must update billing workflows to submit toxicology testing claims (codes 80305-80307, G0480-G0483) to MCOs instead of the Behavioral Health Administrative Services Organization when testing is performed in-office. Verify MCO contracts cover these services and update billing system routing rules. Ensure documentation supports medical necessity as MCOs may audit these claims.